Ben Hendrix: I think most of my questions have been answered, but I did want to follow up on your comments about the review choice demonstration. And specifically, your decision to continue with 100% pre-claim review in Alabama. I know you’ve had periods of elevated denial activity with fiscal intermediaries in the past. It seems like the sampling election would help you sidestep some of that risk. I just wanted to get your thought process there and kind of how relations with intermediaries are going?
Mark Tarr: Yes. So the relations have gone well thus far around that, particularly majority of our hospitals under Palmetto. We decided — actually, the team decided to continue on with 100% review. It felt like we put in a good discipline with better hospitals around documentation and capturing everything we needed to in the chart and to stray from that just seem like it wasn’t the right thing to do, given the process that we already had put in place. So the hospitals actually help make that decision to stay at 100%.
Douglas Coltharp: The benefit of the 100% pre-claim review, there’s really kind of twofold. One is it allows for a much more iterative process with the MAX, so that we can find out if they’re viewing anything regarding a patient’s appropriateness in our hospitals as either if they’re either viewing it erroneously or if there’s — if they’re perceiving they require a change in our documentation, and we can make that adjustment. The other thing is you get a larger sample size. So one of the risks that’s associated with that 5% pre-claim review is they look at one particular patient and they disqualify that patient that based on a circumstance and then apply that through extrapolation to a broader base. Whereas if we’ve got the 100% pre-claim review they’re out there, we can line that patient that they may be contesting up with many others that have been approved elsewhere in their organization and say, you tell us what’s different.
So we just think because the infrastructure is already in place and procedures already in place, that this is the right way for us to proceed through cycle 2.
Ben Hendrix: And just is the added cost of the 100% material?
Douglas Coltharp: No, it’s already in place.
Operator: [Operator Instructions] We’ll now hear from Brian Tanquilut with Jefferies.
Brian Tanquilut: Congrats on the quarter. I actually just have other questions. Maybe, Doug, can you share with us the — what it looked like in terms of the growth rates in different diagnoses of patients coming in? I guess where I’m coming from is, as we think about broader utilization strength, just curious if it’s specific to stroke? Or are we seeing more from like elective procedures such as drug replacements?
Douglas Coltharp: The story is really pretty consistent with what we saw in the back half of last year. So good growth in neurological and stroke in the quarter. Neurological was up just north of 10%. Stroke was up almost 12%. We did see a pretty significant increase in brain injury. That was up 11.1%. And — Other ortho was up almost 16%. But again, remember, that’s off of a smaller base. So we are seeing a broadening in terms of some more rapid growth in some of the smaller categories that have gotten deferred for a period of time during COVID, but the strength in our higher acuity categories continues to be there as well.
Mark Tarr: Brian, there’s electric procedures. We just don’t see a lot of them matter of fact, I mean, for just joint replacement, it’s a little bit less than 3% of our total patient mix. So it’s not really had a large impact on us.
Douglas Coltharp: One of our smallest categories, but knee and hip replacement was up 20% during the quarter.
Operator: Our final question will come from Jared Haase with William Blair.
Jared Haase: Maybe I’ll just ask one around the Change Healthcare disruption. And specifically, I know you mentioned kind of some of the work you did to implement workarounds and maybe enhance or build out some of your internal capabilities. I’d just be curious, any particular areas of interest that you called out where you made investments or sort of built out those workflows. And then I guess the other question is just should we think about any leverage benefit from that just in terms of you internalizing a little bit more of the sort of RCM capabilities?
Douglas Coltharp: Yes. So you think about how we and how most providers utilize change, it was for 2 things. One is what is called claims scrubbing, which is just to make sure that as you or setting a claim to any particular payer, whether it’s CMS through one of the intermediaries or to one of the Medicare Advantage or managed care players that for getting the documentation in the form that is most readily acceptable and desired by that particular payer. The second thing is that for us and for others Change really served as the electronic intermediary in terms of submitting the claims and getting those processed. The primary thing that we did internally was establish our own electronic interface with CMS and now extending that to other payers as well.
Whether or not there’s going to be any kind of leverage that ultimately comes from that, I think it’s going to depend on a go-forward basis between the balance that we have in restoring claims processing through change, these other third-party vendors that we identified and put in place during the process and how much we choose to do internally. It’s still somewhat of a dynamic situation. We will refrain from going back to a situation where we have an overdependence on any one single vendor.
Mark Tarr: Sure. I do want to call out our teams and our centralized billing office down in Tampa as well as our IT staff because they worked extremely hard to minimize the impact on this and figure out work around to come in at night from the weekends to make sure that we were being taken care of from a company standpoint. So I did want to point that out.
Jared Haase: Yes, that’s great to hear.
Mark Tarr: All right. Thank you.
Operator: That will conclude the question-and-answer session. I will now turn the call over to Mark Miller for any additional or closing remarks.
Mark Miller: Thank you, operator. If anyone has additional questions, please call me at (205) 970-5860. Thank you again for joining today’s call.
Operator: This does conclude today’s conference. Thank you for your participation. You may now disconnect.
